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Methadone Coverage Update

August 2, 2017

Upon renewal, Methadone maintenance treatment for treating opioid use disorder will now be covered as a standard benefit for UnitedHealthcare fully insured and self-funded business as follows:  

Fully Insured

  • Large Group – Effective upon renewal for plan years starting on or after July 1, 2017. (Exceptions:  Jan. 1, 2017 for New Mexico; March 1, 2017 for Washington).
  • Small Group – Effective upon renewal for plan years starting on or after Jan. 1, 2017.

Self-funded

  • Effective upon renewal for plan years starting on or after Jan. 1, 2018.

Methadone treatment for pain cotinues to remain a standard covered benefit for fully insured and self-funded business. 

Background
Prior to 2017, coverage for methadone maintenance treatment for treating opioid use disorder was standardly excluded from UnitedHealthcare fully insured plan designs unless otherwise mandated by state law. 

Methadone maintenance helps those diagnosed with opioid use disorder:

  • As part of a medication assisted treatment (MAT).
  • Is both clinically effective as well as cost effective.
  • Supports mental health parity for plans that cover methadone when used for medical purposes.  

Communications
Your customers will receive this information via their respective Connection newsletters in August. For more information, please contact your representative.

January 1, 2017 PDL Updates


The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2017. Learn more

New Sales Automation Management Tool


Check out our new Sales Automation Management (SAM). Learn more

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